Being alive

On growing old, and the health care crisis

(This blog-post was originally published in January, 2017. The current CBC Marketplace investigation being featured by the public network prompts me to reblog, to make the point that this crisis — and that’s what it is — is not new. It’s also worth looking at again because Ontario’s Conservative, Ford government is now in charge, and that doesn’t bode well. And for the record I am well into my senior years, so this is personal.)

First, full disclosure: I am a senior. I have been for more than a few years. I am also the main caregiver of a much older, beloved family member. For some months now we have appreciated the help of the Community Care Access Center (CCAC) in Owen Sound, and the Personal Support Workers (PSWs), visiting nurses and other medical professionals who come to our home. Their genuinely caring attitude has been an important part of the homecare help they provide.

This first-hand experience with the homecare services offered by the Ontario government has been a continuing learning experience. I have, for example, noted with interest that in difficult negotiations with the federal government the provinces and territories have asked for more health care money, in large part to help cover the increasing costs of homecare.

I’ve been led to think and wonder about a lot of things, like what is the future of seniors’ health care, especially the very old? What are the limits of homecare; and what does the future hold for the very old when they can no longer manage or afford to live in their own homes?

Our home sweet Hope Ness home

I was already beginning to get the sense of a big, complex problem when I went looking for more on-line information and happened to find the Ontario Ministry of Health and Long Term Care’s “Action Plan,” from 2012.

It turns out to be more the beginning of a process that four precious years later has led to an actual plan, in the form of The Patients First Act, approved early last month by the Ontario Legislature. But even that is just a beginning of sorts as the province tries to meet the daunting and urgent financial challenge spelled out in the 2012 document.

It was eye-opening, even a little scary:

“The health care system is facing unprecedented challenges,” it says, under the heading of Demographic and Fiscal Challenges. “Most prominent among them are the demographic and fiscal challenges. Our population age structure is changing. We’re living longer and baby boomers are reaching the age where they’ll need more health care. Just as our education system responded decades ago to the baby boom, today’s health care system must now prepare for the demographic shift that will double the number of seniors living in Ontario over the next 20 years.

“Of course the older we are, the more we depend on our health care system. The cost of care for a senior is three times higher than for the average person. Indeed, if we didn’t change anything, kept the age-specific costs what they are today and applied them to the 2030 population, our health costs would increase by $24 billion – 50 per cent more than today from changing demographics alone.

“Even if the province wasn’t facing serious economic pressures, the health care system would still need to transform to address the coming demographic shift. Today, health care consumes 42 cents of every dollar spent on provincial programs.

“Without a change of course, health spending would eat up 70 per cent of the provincial budget within 12 years, crowding out our ability to pay for many other important priorities.”

That last sentence is especially astonishing and worrisome. It might as well have gone one step further and said the present rate of health-care spending under the current system is unsustainable.

It’s a financial crisis, not just in health care for the elderly, but in health care generally. And considering the cost of Canada’s universal health-care system, it’s a national crisis. The total cost in 2016 is expected to reach $228 billion, according to the Canadian Institute for Health Information.

This crisis has been building for a long time, as long there’s been a baby boom generation. It was often called “the post-war baby boom,” but it actually began during the Second World War here in Canada and, I presume, the U.S. when the soldiers joined up in their many thousands and headed overseas. In my father’s case, that happened in 1943, the year I was born.

The wartime boomer-generation cohort was big enough to start the demographic tidal wave that continued in the post-war years of the late 1940s and 1950s and had such an enormous multi-faceted, “boom and bust,” socio-economic impact, decade after decade. For a while Canada had one of the highest birth rates in the world.

Among many other things, the boomer generation spawned housing booms, suburban sprawl, and the building of lots of new schools to meet demand.

And now many of those schools are closing or threatened with closure, including here in Grey-Bruce. The boomer wave moved on long ago. That’s the nature of it. Making some other good use of those buildings may be the best that can be hoped for.

The Patients First Act’s renewed focus on expanding homecare services as part of an integrated, team-based approach to health care that also emphasizes good, foundational health and primary care is a thoughtful response to the huge financial challenge of the boomer wave growing old.

The Ontario Health and Long Term Care ministry has no plans calling for the construction of new Long Term Care facilities. There are currently 78,000 LTC units, or beds, in the province. There are however plans to renovate 30,000 long-term care units in 300 older, long-term care homes by 2025.

Meanwhile, by the year 2035 Ontario’s senior (over 65) population is expected to be more than 4 million, or 24.5 percent of the projected total population in the province.

Even if a million of those seniors live into their 80s or 90s, that’s a lot of homecare, and possibly a much greater need for more long-term care beds than what’s currently available.

The sign at the entrance to Cathedral Drive says “No Exit,” and I’ve tended to take that to heart, as in never having to leave.

But reality is what it is; and I’m beginning to realize that certainly sums up one of the big lessons that comes with growing old. As long as I still felt young I could treat aging like just another oversight – no big deal, do it tomorrow.

The other important lesson is make the best of these precious moments at home in beautiful Hope Ness while we can.

A version of this was originally published in The Sun Times in January, 2017